USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1904-1906 > Part 20
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PLACE OF BURIAL OR REMOVAL II abugton- mars
DATE OF BURIAL
mar 28TE
190 6
UNDERTAKER
6.RB enmani
ADDRESS
Winthat
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 3/18 190.6 .. to 3/25 190 6 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
(DURATION). ....... . DAYS
Contributory :
10
(DURATION).
DAYS
(Signed)
M.D.
3/27 1906 (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence
How long at
Place of Death 7
.Days
Where was disease contracted, If not at place of death ?
Filed
.190
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, glve facts called for under "Special Information." If in a Hospital or Institution, give Its NAME instead of street and number. t In case of married or divorced woman, or widow. # State or country; also city, town or county, If known.
§ Name and address of person giving statistical details. Il Name of cemetery.
ALL NAMES TO BE IN FULL
22 March 25 1906 Mary M. Freeman
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Chyner
Registered No.
Svarchick Mass
Place of Death *
Date of Death
Manic 2nd 1906
Age
Stell Born
.. months . .days
STATISTICAL DETAILS
SEX
Male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
-Celyner
BIRTHPLACE + 1
NAME OF
FATHER
Robert. L. Celyner
BIRTHPLACE
OF FATHER+
Old Virginia
MAIDEN NAME
OF MOTHER
Mary Portion
BIRTHPLACE
OF MOTHER #
Livceden
OCCUPATION
INFORMANT § facher
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last
illness, from
190
..... to
.190
that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
Premature delivery
(DURATION).
OAYS
Contributory :
Incident to Brush
( OURATION).
.DAYS
(Signed)
By Mel call
apm 39
1906
.(Address)
Worshop mas,
M.D.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or
Usual Residence
Place of Death ?
Days
Where was disease contracted, If not at place of death ?.
Filed
190
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, glve facts called for under "Speclal Information." If in a Hospital or Institution, give Its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or country; also city, town or county, If known.
§ Name and address of person giving statistical details. il Name of cemetery.
PLACE OF BURIAL OR REMOVAL !!
UNDERTAKER C. R13 crimson
DATE OF BURIAL
Chil 4T
6
190 ..
ADDRESS
How long at
Clyner April 2 1906
FORM C.
Commonwealth of Classachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Sex. «
Color,
Date of Death, April 3rd
1906; Age, 42
Years, - Months, ~~ Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Finally
Occupation,
Clarke
x 920 Pau liny Of Winthrop Mais
*Residence, { If out of town, {
¿ also state fully.
Dochroter mais.
Place of Birth,
*Place of Death,
92 Paulina it's Hinteron Mars.
Name and Birthplace of Father,
Estrick
Gerland
Maiden Name and Birthplace of Mother, margaret boudny
Place of Interment, (Give name of Cemetery),
Old sorchester, tam, Bodow
Dated at,
April 3 rdl
19010.
Signature and place of business of Undertaker.
x146 2/ interop KL
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Luke T. Brennan
Age, 42 Y. - M. ~ D.
Place and Date of Death,
Primary,
Diabetes
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
A. B. Forman
M. D.
of
Certifylng Physiclan.
Wanthiof Mars
Date of Certificate,
April 4th
1906.
· Give also street and number, if any. t Give sex of infant not named. If still-born, 80 state.
{ If a Soldier or Sailor In the War of the Rebellion, give both Primary and Secondary Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
on ..
died at.
Wentto Mach.
Disease or Cause )
of Death, #
Secondary,
,
No. 2H
RETURN OF THE DEATH
OF
Luke T Breman
at
Date, April 3
190.
6
Filed,
30
190 6.
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funercal rites preliminary to the internient of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]
SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to thic Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CIT
OR TOWN.)
FULL NAME
Laura
Stuart Crais
Registered No.
Date of ¿
Death
apr. 4
190 6
Residence
13 Upland Gon Dorchatted
Age
7
. years.
8
months 29 .days
STATISTICAL DETAILS
SEX Mal
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť
HUSBAND'S NAME +
BIRTHPLACE #
Dorchester
NAME OF
FATHER
BIRTHPLACE
OF FATHER#
At. alkane, Yo.
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER #
annapolis n.A.
OCCUPATION nome.
INFORMANT § Factur
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased-during last illness, from apr. 3 1906 ... to Cfr. 4 1906, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
..
(DURATION).
DAYS
Contributory :
(DURATION) DAY8
(Signed)
HI. Partis
M.D.
apr- 4 1906 (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents. How long at Place of Death ? years. .. months .. .................... . days
Where was dlsease contracted, If not at place of death ?
....
Filed
.190
Clerk
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
Cfr.
6.
. 1906 ..
UNDERTAKER
A. S. E. F. Gleason
ADDRESS
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
# State or country; also city, town or county, If known.
§ Name and address of person giving statistical detalls. Il Name of cemetery.
Place of l
Death *
Lana Form Ler: Winthrop
Lawrence / granero Abril 4 1906
3
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
: FULL NAME Theodore.
Collamore
Registered No.
Place of Death
19 Prospect Core Winchester
Date of Death
Cefil 4th
Age
82
... years.
X
.months
X
.days
STATISTICAL DETAILS
SEX
Male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE#
Pembroke Man
NAME OF FATHER anthony Collamore
BIRTHPLACE OF FATHER# Scituate Mass
MAIDEN NAME
OF MOTHER
Lydia Windstoi
BIRTHPLACE OF MOTHER # Interim
OCCUPATION Petit. 6
INFORMANT § Wife
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last Illness, from March 22 1906 to apr 4. .1906; that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
(DURATION)
15
DAYS
Contributory :
(DURATION) .. DAYS
*(Signed)
M.D.
190.5 ... (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence
How long at Place of Death ? Days
Where was disease contracted, If not at place of death ?
Filed
190.
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give Its NAME instead of street and number.
t In case of married or divorced woman, or widow. # State or country; also city, town or county, If known.
§ Name and address of person giving statistical details. Ii Name of cemetery.
ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL II Auchunter Comelang
DATE OF BURIAL
190. 6
ADDRESS
UNDERTAKER
la Ri Pernueva
2
Theodore Collamore Abril 4 1906
1
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Chelsea ...
(CITY OR TOWN.)
FULL NAME
Turner
William a
.Registered No. 206
Place of }
Death * S
..
Chelong
Frost shoopital
Date of
Death april 4-190€
Age .. 5
.years
months.
... days
STATISTICAL DETAILS
SEX
m
COLOR
w
STHOLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME'T HUSBAND'S NAME +
BIRTHPLACE #
Bucksport me
NAME OF
FATHER
William
BIRTHPLACE
OF FATHER+
Provincetown mass
MAIDEN NAME
OF MOTHER
Sarah Coombs
BIRTHPLACE
OF MOTHER+
Buckshort me
OCCUPATION Stevedore
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 190 .to
190 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
Frac of skull to
accidental
Fall
(DURATION).
.DAY&
Contributory :
(DURATION) DAYS
(Signed)
J. a. Harris
M.D.
190
.(Address)
SPECIAL INFORMATION only for Hospitals, Institutlons, Transients, or Recent Residents.
How long at
Place of Death ?
years
....... ...... months. days
Where was disease contracted, if not at place of death ?
Filed
april 5-1906.
Chari.
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclal Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country ; also city, town or county, If known.
§ Name and address of person giving statistical details. | Name of cemetery.
ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL I
DATE OF BURIAL
Woodlawn" Everett
190 ..
ADDRESS
UNDERTAKER C. R. Bennison
-
Residence
Winthrop
INFORMANT §
apr. 4, 1906
registration.
|[4.'04-37-LM.]
· Permit No. .
RETURN OF DEATH.
0 BOSTON, MASS.
Date of Death,
Movie 5"1906
Name in full, Sethia Gelchen
Granen Gelcher
(If a married or divorced woman give maiden name, also name of husband.)
Female
.
Color,
While
Condition,
Married
Sex,
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Age, 78 Years, 2 Months, C
Days. Occupation, -
Residence,
Mass
Ward,
Place of Death,
4my Sh inttrop Sheel
Place of Birth, Chatham Mass Date of Birth,
(State year, month and day.)
Law 16 "1827
Name and Birthplace ?
of Father,
Joshua Garding-Chatham Mass
Maiden Name and Birthplace of Mother, Bethia Guarding-Chatham mass
Place of Interment, ..
Summer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Hinther/ Boston,
April 6th
1906.
Name and Age ? Bettina Belchen
of Deceased,
Date and Winthrop Mars, April 5th 1906.
Place of Death,*
Chief cause, .
Bright's Disease
Disease < Contributing cause, .. Age. Bronchitis
Chief cause,
.. .. ...
Duration Contributing cause, ...
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ? of Physician, A.B. Norman M.D.
* If an institution, state how long an Inmate and previous residence.
D21
Fan!
C
Age, 78 years.
Bertha Belcher April 5 1906
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Chapman
TEabury
Registered No.
....
Place of Death *
21 Charles JK
Winthrop
mars
Date of Death
april 13 rd 1906
Age
72
... years
9
months
days
STATISTICAL DETAILS
SEX
male
COLOR
white
SINGLE MARRIED, WIDOWED, OR DIVORCED
widower
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE +
Orleans Mass
NAME OF
FATHER
Isaac Labiry
BIRTHPLACE
OF FATHER$
MAIDEN NAME
OF MOTHER
REbraca Grey
BIRTHPLACE
OF MOTHER +
Orleans mais
OCCUPATION
Coleta
INFORMANT § nece
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .. 4 190 6to ap. 13. 1906 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Labas Are
(DURATION).
.DAYS
Contributory :
(DURATION).
DAYS
(Signed)
M.D.
apr 14 1906 (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or
Usual Residence
How long at
.Place of Death ?
Days
Where was disease contracted,
If not at place of death ?.
Filed
190
Clerk
PLACE OF BURIAL OR REMOVAL II
Orleans muss
DATE OF BURIAL
april 16th,
190℃
UNDERTAKER
C. R. Bennison
ADDRESS
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If in a Hospital or Institution, give its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country; also city, town or county, If known.
§ Name and address of person giving statistical details. Il Name of cemetery.
ALL NAMES TO BE IN FULL
Chapman Heahury Afrel 13 1906
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
fred, newton Russell fun
.Registered No.
Place of Death *
Date of Death
april 14 # 1906
Age
2
. years
1
months.
18
days
STATISTICAL DETAILS
SEX
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE +
Sunderland Man
NAME OF
FATHER
thed Mentor Russell. C.
BIRTHPLACE OF FATHER# Sunderland Mass
MAIDEN NAME
OF MOTHER
Jury aukens
BIRTHPLACE
OF MOTHER+
Springfield
OCCUPATION
INFORMANT §
morten + facher
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from afr q1 1906 to apr 14" 19016, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Broncho Pneumonia
(DURATION)
5
. DAYS
Contributory :
(DURATION) DAYS
(Signed)
Birmetcalf
M.D.
apr 15
190.6 (Address)
worthof mass
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence
How long at Place of Death ? Days
Where was disease contracted, If not at place of death ?
Filed
...... 190
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If in a Hospital or Institution, give its NAME instead of street and number.
t in case of married or divorced woman, or widow. # State or country; also city, town or county, If known.
§ Name and address of person giving statistical details. Il Namo of cemetery.
ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL II Wout Hadley Mans
DATE OF BURIAL
abril 16
190 6
UNDERTAKER
le. R. Person.
ADDRESS
Fred Newton Russell for. April 14 1906
[4-'04-37-L.M.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death, aparie 14" 1906
Name in full, Charles . It, Miller
(If a married or divorced woman give maiden name, also name of husband.)
Sex, male
Color While
Condition,
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
.Age, Years, ...
Months, .. Days. Occupation,.
Residence,
Ofanthrop Mass
Ward,.
Place of Death, 63 Bandoi Street
(State year, month and day.)
Place of Birth,
Date of Birth, Man 1" 1902
Name and Birthplace ? of Father,
auchak P. miller Turky in asia
Julia E, Shepard- Rockland maine
Maiden Name and Birthplace of Mother, Place of Interment, Orinthiop Cemetery
Summer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Drifturp ajerie , 190.6
Name and Age )
of Deceased, Charles v.Dr. müller .Age, .. years.
Date and 63 Bondmin St apr 1x 06
Place of Death,*
Disease
Chief cause, Suffication due to accidental cause
Contributing cause,. Chief cause,
Duration Contributing cause,
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ? of Physician, 131met calf M.D.
* If an institution, state how long an inmate and previous residence.
)21
April 14 1906 Charles TOWN Miller
|[4.'04-37-LM.]
Permit No.
RETURN OF DEATH.
Winthrop
BOSTON, MASS.
Date of Death,
Capone 15/1906
Name in full, Grace Patchel
(If a married or divorced woman give maiden name, also name of husband.)
Sex, Female Color
(White, Black, Mixed, Chinese, Indian, etc.) Occupation,
(Single, Married, Widowed or Divorced.) ١٠٠٠٠
Age, 30 Years,
Months,
Days.
Residence, Printtrop Mass
Ward~
Place of Death, 119 Shirley Sheet
Place of Birth, Salem Wass
(State year, month and day.)
Date of Birth, may 4" 1876
Name and Birthplace ) of Father,
James arrington- Salem Swase
Maiden Name and Melinda R Beckford Salem man Birthplace of Mother, Place of Interment, antropo Cemetery - Winthrop, mass Summer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Łoń, ajerie 1
1906
Name and Age ? of Deceased,
Prace Patchet
Age, 30 ..... years.
Date and April 15th 1906. 119 Stile Sr.
Place of Death,* Chief cause, -Bright demora, Acute dilatation y Hearia, Cederna
Disease Contributing cause, Pregnancy
Chief cause,
Duration Contributing cause,.
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ? of Physician, S .. Albert B. Norman M.D.
* If an Institution, state how long an Inmate and previous residence.
021
Condition, married
Grace Patchet April 15 1906
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1906.
CITY OF BOSTON
FULL NAME Henry ... Bloomfield
Registered No ....... 4838 ..
Place of Death ¿
Boston
Cunard ... Wharf .... East ... Boston
and Residence §
Date of Death
Apr 26
1906.
Age.
65
years
2
months
15
lays
STATISTICAL DETAILS.
SEX COLOR
SINGLE, MARRIED, WID., DIV.
male
white
married
Maiden Name .....
ST
RAR'S
RIBU SIT DEL Decomposition too far ad-
Husband's Name ..
Birthplace England
CIVITAT
.BOSTONTA CONDITA AL
TA
1830. Composed to have fallen overboard BOSTON. MA
Birthplace
of Father
England
Maiden Name
Mary ... A ... Willis
Birthplace
England
of Mother
Occupation Stevedore
Informant
Contributory : 2 (Duration)
(Signed) Geo Stedman
M.D.
May 30
1906
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Place of Burial
Winthrop Cem Winthrop Mass
or removal.
Usual Residence
Court Pk Rd Winthrop Mass
Undertaker
Sumner Floyd
Filed.
May .... 31
1906.
A true copy.
Attest :
ErMSlenen
Registrar.
R
SIEUT
T PATKI A Primacy (Durafon) OFFICO Vanced Drowning
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
from 1906, to 1906, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Name of Father John
of Mother
Henry Bloomfield April 26 1906
[4.'04.37.L.M.]
-Permit No.
RETURN OF DEATH. Winthrop BE STON, MASS.
Date of Death,
Wway 6.19.06
Name in full, Omma Ppervagy
Emma Putnam Munne@Inevagy (If a married or divorced woman give maiden name, also name of husband.)
Sex, Female Color, While-
Condition, ... Married
(White, Black, Mixed, Chinese, (Single, Married, Widowed or Divorced.)
Indian, etc.)
Age, 51 Years, 2 Months, ~Days.
Occupation, Consente
Residence,
Mass
Ward,
Place of Death, 3. Buchanan Strel
Place of Birth, Charlottetin DE.Q, Date of Birth,
Name and Birthplace ) of Father, Maiden Name and Birthplace of Mother, Place of Interment,
John Partiram -
England
Dane Bridges- 9 6. Deland
Summer Hoyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, may 6 1906
Name and Age ? Emma Devargy
Age, 51 years. 2 mos
Date and 1 May 6" 1906. 3. Buchanan Street
Place of Death,* S Chief cause,. Cancer of towels
Disease Contributing cause,.
Ulcuración
Chief cause, 21/2 years
Duration Contributing cause,. 16 days
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ? of Physician, M.D.
* If an institution, state how long an Inmate and previous residence.
2 1
of Deceased,
(State year, month and day.)
Emma /neworgy, May 6, 1906,
-
[3.'06-37-LM.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Name in full,
Date of Death, May 8. 400 Mary Source Pova Con Truchon A widow of famer. ). (If married or divorced woman giye malden name, also name of husband.)
(White, Black, Mixed, Chinese, Indian, etc.) Condition Sex, CH Color,
(Single, Married, Widowed or Divorced.)
Age, 14 Years, ~ Months, .~ Days. Occupation,
Residence,* 600 of Bartlett Road Pluma LeWard,
Place of Death, Withina
Place of Birth, Chambly Canada Date of Birth, (State year, month and day.)
Name and Birthplace \ Petit
Ceambly Canada
of Father, Maiden Name and Birthplace of Mother, S Place of Interment, Holy Cross
Unbuon Baratto
1 tin Le Lane Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Nurthiof Mass, May 10th Boston, 1
1906.
Name and Age ? of Deceased, Mary Louise Pero Age, 74
years.
I hereby certify that I attended deceased from May 4th
1906, to May 1X
1906, that I last saw
alive on the. 6/5 day of May 1906 that the died on the
day of May 1906, about. /Q .. o'clock
A.M., F., and that, to the best of my knowledge and belief, the cause of.
her death was as follows :
Disease 3 Chief cause, Age, Acute Indigestion
Contributing cause, Sudden Weakening and failure of the hearts action.
Chief Cause,
* If an Institution, state how long an inmate and previous residence.
Duration Contributing cause, . Albert B. Domman M. D.
Mary House Tero May 8 1906
([4.'04-37-LM.]
. Permit No.
RETURN OF DEATH. mutuo? BOSTON, MASS.
Date of Death, .. May 18 1906
Name in full,
John mainnghie
(If a married or divorced woman give maiden name, also name of husband.)
Sex, male Color White Condition,
18
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 6 Years, ~ Months, ... /2 Days. Occupation,
Residence, Justtwo giraso
Ward,
Place of Death, 123, Smiley Street
Place of Birth,
Salvatarie Maninghiel 1) Date of Birth, May 6"1900
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother,
Marquentto Capacto
Place of Interment, Old Cambridge Cartulina Queles Summer Floyd Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, May 18. 190 6
Name and Age ? of Deceased, S John mainnghie Age, 6
years. 122
Date and Place of Death,* S May 18" 7906 123 Shuly Rleet
Chief cause, Austic Ino
Disease Contributing cause,
Chief cause, 3 days.
Duration - Contributing cause,
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ) of Physician,
M.D.
* If an institution, state how long an inmate and previous residence.
21
(State year, month and day.)
Perley A Morte May 28 1906
John Maninghil May 18 1906
[4.'04.37.I.M.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death, May 24" 1906
Name in full, Orie Way Daggett 0
(If a married or divorced woman give maiden name, also name of husband.)
Sex, Stemale Color While Condition,
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or
Divorced.)
Age, ~ Years, ~Months, /2 Days. Occupation,
Residence, Printhop mass
Ward,
Place of Death, 13 Ofutchinen Street
(State year, month and day.)
Place of Birth, .... 、 11
1, Date of Birth, May 24 "1906
Name and Birthplace ) of Father,
Frank ayer Daggett- Raftany mass. Maiden Name and Charlotte may allen Worcester mass
Birthplace of Mother,
Place of Interment, Printtrop Cemetery
Summer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
ing 16 1906
of Deceased, Orie Way Daggett Ace 1 Day
Age, .. years.
Date and Way 24" 1906, 13 Hutchinson Sheel
Place of Death,* S
Chief cause, .. Premature.
marasmus' ..
Disease Contributing cause,
Chief cause, 1/2 days
Duration Contributing cause,
I certify that the above is true to the best of my knowledge and belief.
Name and Residence of Physician, U.S. You can M.D.
* If an institution, state how long an inmate and previous residence.
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